Overcoming the “Dirty Little Secret” – Part 2

In my last post, I discussed the “dirty little secret” that many medical groups suffer from, and recommended that all medical groups should ask and answer the following questions:

1. How will the group make decisions? (Best answer: discuss and vote).
2. What is expected of each physician once a decision has been made? (Best answer: adhere to and support the decision).
3. What are a physician’s options if he or she doesn’t like the decision? (Three options only: a. Do it anyway, that’s group practice; b. Try to get it changed in the proper forum, but keep adhering to the decision until it is changed; or c. Self select yourself out of the group).

The answers to these questions determine whether or not a group will be able to build an effective system of governance.

There are four additional important reasons that groups should ask and answer these questions:

1. Leads to real discussions: In our experience physicians tend to be conflict avoiders, when it comes to physician-to-physician conflict (we will discuss this further in future posts). In many groups, an individual physician “knows” that he or she will not be held accountable in regards to adherence to group decisions. If this is the case, the physician may avoid talking about an issue in a group meeting, counting on the fact that no one will challenge their non-adherence to group decisions at a later time. Their thought process seems to be: “I can avoid conflict now by not speaking up, and I can probably avoid it later as no one will challenge me – because they are all conflict avoiders also.” However, if each group member pre-commits to adhering to group decisions it is much more likely that they will raise dissenting opinions as part of the discussion. This means that the group will have a more complete and richer discussion about the issue.
2. Eliminates the fiction of unanimity: Many groups spend hours and hours trying to get everyone to vote for an issue, thinking that if everyone “agrees” then it will be much easier to implement the decision.  But it’s likely that everyone doesn’t agree – in the end they just vote for the issue to avoid conflict in the meeting They then turn right around and ignore the decision.  Stop wasting time with pursuing false unanimity. Get people to pre-commit to supporting group decisions.
3. Avoid “making pasta:” How do you know when pasta is ready to eat? Throw it against the wall and see if it sticks. Unfortunately that’s how many medical groups operate – let’s make a decision and be hopeful that people adhere to it (that it sticks). In my view, why waste a lot of time struggling with decisions if adherence is optional?
4. Many issues/little time: Group governance and meetings can consume a substantial amount of time.  It is exhausting, frustrating and excessively time consuming to have to guess whether or not people will support each and every decision. Groups whose members pre-commit to support group decisions function much more effectively than those that suffer from the “dirty little secret.”

It is true that not everyone will live up to their commitments in regard to group decisions. As James Madison said, “if men were angels, no governance would be necessary.”  In later posts we will discuss how to deal with those who do not follow group policies.  But, as an important first step, ask people to pre-commit to adhering to group decisions.

Please contact me if you’d like to discuss this post.

Will Latham
wlatham@lathamconsulting.com